SlipstreamJobs tracks this role from the company's public career site. Apply directly on the employer's site.
Foundation Health is an AI operating system for pharmacy, built by a team with deep domain expertise. The platform is live in production at major US health systems, handling real patient communication via voice and SMS, integrated directly into Epic workflows. The company is ~70 people, past product-market fit, raised $20M Series A (led by Define Ventures), and the CEO is a 2x founder.
In this Principal Software Engineer role, you will own architecture across several product areas and design systems capable of scaling 10–100x without rewrites. You'll be the engineer who tackles the hardest problems in the company, building first versions and setting technical direction. You'll also elevate the rest of engineering through mentoring, cross-team project leadership, and improving how the company builds—including leveraging AI to ship faster without sacrificing quality.
Key problem areas you'd own:
1. Agentic AI for patient safety: voice and SMS agents, evals, guardrails, red teaming, and pharmacist-oversight design. Production LLM safety and security experience is highly valued.
2. Deep EHR integration: Epic queues, prior authorization automation, 340B compliance—where correctness is critical and specifications are complex.
3. Target-state architecture: scaling from a handful of health systems to hundreds, building the first phase of that migration.
4. AI engineering practices: model selection, context management, cost/latency tradeoffs, and evaluation methodology.
You'll work directly with the VP of Engineering (ex-DeepMind) and CEO. The company is remote-first across the US with an engineering hub in downtown Orlando (occasional visits expected). Eastern or Central time is preferred due to UK engineering team overlap.
Qualifications and background that tends to succeed:
- Recently built serious systems with your own hands; can go deep on details of shipped work. Title is less important than demonstrated technical depth.
- Staff+ level experience at a high-bar organization with architectural decisions the company still runs on.
- Production LLM experience beyond SDK calls: agents, tool use, evals, guardrails, reliability engineering.
- Preference for simplicity: well-structured monoliths on Postgres over premature microservices; architecture changes driven by real constraints, not speculation.
- Experience in domains where mistakes are expensive (healthcare, fintech, fraud, trust & safety, compliance-heavy industries). Healthcare domain knowledge is not required; rigor and care about correctness are.
- Ability to identify and solve the highest-leverage problem in the company without waiting to be directed.
- Founding-role equity package reflects early stage.
